title: Special considerations for treatment of type 2 diabetes mellitus in the elderly.
abstract: OBJECTIVE
  The intensity and selection of therapy for the treatment of type 2 diabetes mellitus in elderly patients are discussed.
  
  
  CONCLUSIONS
  Glycemic control is fundamental in diabetes care; however, as glycemic goals are approached, the risk of hypoglycemia increases. This risk is even greater in the elderly due to many predisposing factors, including renal insufficiency, polypharmacy, drug-drug interactions, comorbidities, irregular meal patterns, and infrequent self-monitoring of blood glucose. When deciding on the desired intensity of diabetes treatment, the risk of hypoglycemic complications must be weighed against the potential benefit of reducing microvascular and macrovascular complications. Three large-scale, randomized controlled trials examining the effects of intensive versus standard glycemic control on microvascular and macrovascular outcomes in patients with type 2 diabetes have been published in recent years. In general, a glycosylated hemoglobin (HbA(1c)) goal of <7% is reasonable for most patients. A less-aggressive goal may be considered for patients at high risk of hypoglycemia or high risk of complications from hypoglycemia, as long as acutely symptomatic hyperglycemia is avoided. Chlorpropamide, glyburide, and rosiglitazone, which pose a great risk for hypoglycemia, should be avoided in the elderly.
  
  
  CONCLUSIONS
  In the absence of clear evidence advocating strict glycemic targets goal of <7% is for elderly patients, an HbA(1c) reasonable for most patients; however, the risk of hypoglycemic complications must be weighed against the potential benefit of reducing microvascular and macrovascular disease. Metformin may be used as first-line therapy, but chlorpropamide and glyburide, which pose a great risk for hypoglycemia, should be avoided in the elderly. Due to increased cardiovascular risk, use of rosiglitazone in the elderly should also be avoided.
authors.affiliation: Department of Pharmacy Practice and Science, College of Pharmacy, University of Iowa, Iowa City, IA 52242-5000, USA.
authors.forename: Michelle A
authors.initials: MA
authors.lastname: Fravel
authors.forename: Deanna L
authors.initials: DL
authors.lastname: McDanel
authors.forename: Mary B
authors.initials: MB
authors.lastname: Ross
authors.forename: Kevin G
authors.initials: KG
authors.lastname: Moores
authors.forename: Mary J
authors.initials: MJ
authors.lastname: Starry
mesh_terms: D000367:Age Factors; D000368:Aged; D001786:Blood Glucose / Q000187:drug effects*; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000503:physiopathology; D004347:Drug Interactions; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007004:Hypoglycemic Agents / Q000009:adverse effects / Q000494:pharmacology / Q000627:therapeutic use*; D019338:Polypharmacy; D012307:Risk Factors
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents